mpanying longitudinal tracks formed a class rather apart
in the matter of symptoms. In these mere groovings might also be
accompanied by no signs, or at the most by slight local pain and
tenderness. When, however, the grooving was sufficiently deep to be
accompanied by deformity, or a complete solution of continuity was
effected, the signs were often severe. The tender salient angle, or, in
the absence of this, a highly tender localised spot, often pointed to
the less severe injuries, and when the fractures were complete or
multiple, pain was a very prominent symptom, both constant and in the
form of inspiratory stitch. The severity of the pain was probably to be
in part ascribed to implication of the intercostal nerves, which in
these injuries was direct and often multiple. Again, severe contusion or
actual laceration of the nerves, with resulting anaesthesia, was less
common than when the bullet directly implicated the nerves in transverse
wounds. Free comminution and absolute solution of continuity were also
less common than in the fractures accompanying transverse wounds; hence
pain from rubbing of the fragments on inspiratory movement or palpation
was more common, and crepitus, either on auscultation or palpation, was
more often met with. Patients with this class of fracture often suffered
greatly from painful dyspnoea, and were unable to assume the supine
position.

_External haemorrhage_ of severity was rare from these thoracic wounds;
in many cases it did not amount to more than local staining of the
shirt; altogether I saw only one or two cases where any serious bleeding
occurred. Internal haemorrhage into the pleura, in consequence of the
position of the intercostal arteries, was common, and often abundant;
this will be treated of under the heading of haemothorax.

_Treatment of fractured ribs._--Transverse wounds of the thorax, with no
symptoms of fractured ribs, needed to be dealt with as wounds of the
soft parts alone.

In multiple fractures accompanying longitudinal tracks, bandaging or
strapping for the purpose of fixation was necessary to relieve pain. A
few fragments of bone sometimes needed primary removal, and occasionally
small sequestra were removed at a later date; but necrosis was rare,
unless some complication led to the development of a fistula.

Retained bullets were occasionally met with in the chest wall. In such
cases the last remaining energy of the bullet often seemed to have been
spen